Working Spouse/OEI Rule

In order to make sure CMU is able to offer the best coverage possible to those who need it most, the self-funded medical/prescription and dental plans include a spouse/other eligible individual (OEI) eligibility rule. Working spouses/OEIs of CMU staff, fixed-term faculty, medical faculty, and post-doctoral research fellows who have access to coverage through their own employer and the employer pays any portion of the cost of the coverage, must enroll in a minimum of single coverage with their employer.

CMU strongly believes that it’s our responsibility to provide the best healthcare coverage possible to our employees and eligible children, and that other employers should take the same responsibility for their own employees. The truth is that when our costs increase because of spouse/OEI claims, the cost for all of our employees – including employees with single coverage – rise also.

Yes, your spouse/OEI is EXEMPT if they are:

• not employed;
• not eligible for coverage under their employer’s plan;
• working for an employer who does not offer medical/prescription and/or dental coverage;
• only eligible for COBRA continuation coverage;
• employed by CMU;
• self-employed;
  
• eligible for Medicare, Medicaid or TRICARE; or
• enrolled in retiree health coverage.

• The employer’s plan does not have a single-only coverage option.
• The employer’s plan is an HMO or high deductible health plan.
• Your spouse works part-time.

The Working Spouse/OEI Rule does not affect those employees who are married or are in a relationship with an OEI and both work at CMU. Remember, you cannot cover each other and/or children on separate medical/prescription, dental and vision plans. One of you will need to elect two person (employee plus 1 other dependent) or family (employee plus 2 more​ dependents) coverage.

Your spouse/OEI will not be affected by the Working Spouse/OEI Rule. However, if your spouse/OEI becomes eligible for medical/prescription and/or dental coverage through their employer during the year and their employer pays any portion of the cost of the coverage, your spouse/OEI must enroll in at least single coverage with their own employer.

Yes. If your spouse/OEI is enrolled in their own employer’s medical/prescription and/or dental plans, CMU will provide your spouse/OEI with secondary coverage under CMU’s benefit plan. Your spouse/OEI’s employer’s plan will be responsible for the initial processing and payment of claims in accordance with their plan. Any unpaid balances may then be submitted to CMU’s benefits plan for processing under Coordination of Benefits.

The CMU Choices Flexible Benefit Plan Document/Summary Plan Description includes the Other Health Coverage provision. Your spouse/OEI can provide their employer with a copy of the plan document.

CMU Choices Plan Document

If a spouse/OEI loses coverage, the event qualifies as a benefits status change event and your spouse/OEI can be enrolled in CMU’s health plan, if not enrolled. You must submit a completed Status Change Request form to CMU’s Benefits & Wellness office within 30 calendar days of your spouse/OEI losing coverage to be enrolled in CMU’s plan.

Status Change Form

No.

No. Children will continue to be eligible for the CMU Choices benefits plan as long as they continue to meet the eligibility requirements, as outlined in the Dependent Eligibility Criteria Grid​.

Dependent Eligibility Criteria Grid

To be eligible to contribute pre-tax dollars into an HSA, an individual must be covered by an HSA qualifying High Deductible Health Plan (HDHP) and cannot be covered by other health insurance that is not an HDHP. This means that your spouse/OEI will need to decide whether:

• they'll want to enroll in the HDHP and contribute (and/or allow their employer to contribute) pre-tax dollars into an HSA; or
• they'll want to enroll in the HDHP without contributing to the HSA and elect secondary coverage through CMU’s PPO2 plan.

IRS Publication 969